1. Closed reduction of fractures: Basic techniques (a): The direction and magnitude of the causal force (I) and the deformity (2) are related, and may be worked out from the history, the appearance of the limb and the radiographs. Any force required to correct the displacement of a fracture is applied in the opposite direction (3).
4. Basic techniques (d): In some fractures there may be difficulty in reduction due to prominent bony spikes or soft tissue interposition. Reduction may sometimes be achieved by initially increasing the angulation prior to manipulation. This method of unlocking the fragments must be pursued with care to avoid damage to surrounding vessels and nerves.
2. Basic techniques (b): The lirst step in most closed reductions is to apply traction -generally in the line of the limb (I). Traction will lead to the disimpaction of most fractures (2) and this may occur almost immediately in the relaxed patient under general anaesthesia. Traction will also lead to reduction of shortening (3). and in most eases to reduction of the deformity (4).
of reduction may be assessed by noting the appearance of the limb (I). by palpation, especially in long bone fractures (2). by absence of telescoping (i.e. axial compression along the line of the limb does noi lead to further shortening) (3). and by check radiographs.
3. Basic techniques (c): Any residual angulation following the application of traction may be corrected by using the heel of the hand under the fracture (I) and applying pressure distally with the other (2).
6. Basic techniques (f): After reduction of the fracture it must be prevented from redisplacing until it has united. The methods include the following:
For common methods of internal fixation see Chapter 4.
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